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A Case of Hypothyroid Myopathy

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Stanley Medical College, Department of Medicine

A 45-year-old female presented with gradually progressive proximal muscle weakness over 6 months. On examination, she had facial puffiness, macroglossia, hyporeflexia, and delayed ankle jerk relaxation. Investigations revealed hypothyroidism with a high TSH and low T3 and T4. An EMG showed a myopathic pattern. She was diagnosed with hypothyroid myopathy and started on levothyroxine treatment.

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DR. PRIYA KUBENDIRAN M 1 UNIT PROF. DR. MAGESH KUMAR CASE PRESENTATION
A 45 year old female was admitted on 08.11.10 with ,[object Object],[object Object],[object Object]
H/O PRESENT ILLNESS : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SUMMARIZING…. ,[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
GPE : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
SYSTEMIC EXAMINATION : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CNS ,[object Object],[object Object],[object Object],RIGHT LEFT BULK UPPER LIMB AE 20 cm 20 cm BE 19 cm 18.5 cm LOWER LIMB AK 35 cm 35 cm BK 28 cm 27 cm TONE UPPER LIMB normal normal LOWER LIMB normal normal
POWER RIGHT LEFT Neck 2 UL Shoulder Flexors 3 3 Extensors 3 3 Abduction 3 3 Adduction 3 3 Elbow 4- 4- Wrist 5 5 Hand grip 100% 100% LL Hip Abduction 2 2 Adduction 2 2 Flexion 2 2 Extension 2 2
REFLEXES RIGHT LEFT LL Knee 3 3 Ankle 5 5 EHL 5 5 RIGHT LEFT SUPERFICIAL Corneal + + Conjuctival + + Abdominal - - Plantar flexor flexor DEEP Biceps + + Triceps + + Supinator + + Knee + + Ankle + delayed relaxation + delayed relaxation
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],normal
PROBABLE DIAGNOSIS…??
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IMPRESSION : ,[object Object],[object Object],[object Object],[object Object],[object Object]
INVESTIGATIONS : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],S. Electrolytes : Na – 134 meq/L K - 4.4 Cl – 86 Hco3 – 21
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neurological consult : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],? HYPOTHYROID MYOPATHY
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NCS ,[object Object],[object Object]
EMG ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SPONTANEOUS ACTIVITY
MOTOR UNIT POTENTIALS
INTERFERENCE PATTERN
FINAL DIAGNOSIS ,[object Object],[object Object],[object Object]
MANAGEMENT ,[object Object],[object Object],[object Object],As suggested by endocrinologist
COURSE IN THE HOSPITAL
 
 
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PATHOPHYSIOLOGY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PSEUDOMYOTONIC REFLEX ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object]
MANAGEMENT ,[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object]

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